Art Therapy Insurance Verification
Client Information
Full Name
Date of Birth
Phone Number
Insurance Information
Insurance Company
Member ID
Group Number
Customer Service Phone
Insured’s Name
Relationship to Insured
Plan Details
Plan Type
Effective Date
Deductible (Individual/Family)
Deductible Met
Co-pay
Co-insurance (%)
Out-of-Pocket Maximum
Art Therapy Coverage
Is Art Therapy Covered?
CPT Codes Covered
Session Limits
Authorization Required?
Notes